Healthcare Provider Details

I. General information

NPI: 1457206542
Provider Name (Legal Business Name): MICHAELA MARIE ABREU SUDRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103-1589
US

IV. Provider business mailing address

1432 PEARSON AVE
SAN LEANDRO CA
94577-2436
US

V. Phone/Fax

Practice location:
  • Phone: 415-863-3883
  • Fax:
Mailing address:
  • Phone: 415-862-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: